Epidural Steroid Injections (ESI)

“Epidural steroid injections are a common interventional procedure used to reduce inflammation around spinal nerves and relieve pain caused by conditions such as herniated discs, spinal stenosis, and radiculopathy. By delivering medication directly to the affected area, this treatment can help decrease nerve irritation, improve mobility, and support participation in rehabilitation. As a PM&R physician, I use image-guided techniques to ensure precision and safety for each patient.”

-Dr. Anatoly Pisman, MD

What is an Epidural Steroid Injection?

An epidural steroid injection is a minimally invasive procedure in which anti-inflammatory medication is injected into the epidural space of the spine. This area surrounds the spinal cord and nerve roots, where inflammation often contributes to pain.

The goal of the injection is to reduce swelling around irritated nerves, which can help relieve pain that radiates from the spine into the arms or legs. It is commonly used as part of a non-surgical treatment plan within PM&R and pain management care.

Conditions Treated

Epidural steroid injections are frequently used to treat conditions that involve nerve inflammation or compression.

Types of Epidural Injections

There are different approaches to administering epidural injections, depending on the location and source of pain:

How the Procedure Works

Epidural steroid injections are typically performed using imaging guidance such as fluoroscopy to ensure accurate placement of the needle. A local anesthetic may be used to numb the area before the injection is administered.

The medication is delivered into the epidural space, where it works to reduce inflammation around the affected nerves. The procedure is usually completed in a short visit and does not require surgery or hospital admission.

When Epidural Injections Are Recommended

These injections are often recommended when pain persists despite conservative treatments such as physical therapy, rest, or medications. They may be used to help reduce symptoms, improve function, and support participation in rehabilitation programs.

Epidural injections can also be used as a diagnostic tool to help identify the specific source of pain by observing how symptoms respond to the treatment.

What to Expect After the Procedure

After the injection, patients are typically monitored briefly before being discharged the same day. Some may experience immediate relief due to the local anesthetic, while the steroid medication may take several days to reach full effect.

Mild soreness at the injection site is possible but usually temporary. Patients are often able to return to normal activities within a short period, depending on their individual condition and provider recommendations.

Benefits of Epidural Steroid Injections

Epidural steroid injections can provide meaningful relief for patients experiencing nerve-related pain that interferes with daily activities. By reducing inflammation around irritated spinal nerves, this treatment may help decrease pain, improve mobility, and create an opportunity to participate more effectively in physical therapy and other aspects of recovery. For many patients, it offers a non-surgical option that supports both symptom relief and longer-term functional improvement.

Limitations and Considerations

While epidural steroid injections can provide significant relief, results vary from patient to patient. The effects may be temporary, and repeat injections may be considered depending on the response and overall treatment plan.

These injections are often most effective when combined with other therapies such as physical therapy, exercise, and lifestyle modifications aimed at addressing the underlying condition.

What to Expect at Your Visit

During your evaluation, your symptoms, medical history, and prior imaging (if available) will be reviewed. A physical examination will help determine whether an epidural steroid injection is appropriate for your condition.

If recommended, a personalized treatment plan will be created to address your pain and support your recovery goals.